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Tribute Advantage (HMO-POS D-SNP)

Arkansas Medicare-Medicaid Dual Eligible D-SNP Plan (2023 Plan)

Monthly Premium
Your Cost
$0
by Tribute Health Plans
Additional Coverage
HearingVisionDental
Overall Government Star Rating
No Rating (new plan)

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Plan Overview

Plan Name
Tribute Advantage (HMO-POS D-SNP)
Insurance Carrier
Tribute Health Plans
Plan Type
Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP)
Network Type
HMO

Tribute Advantage (HMO-POS D-SNP) is a Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP), which is available in Arkansas and offered by the health insurance company Tribute Health Plans. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.

Cost Summary

Monthly Premium
$0
Annual Deductible
$0
Max Out-of-Pocket
$8,300
Primary doctor visit
$0 copay
Specialist visit
$0 copay
ER visit
$0 copay
Ambulance
$0 copay

Tribute Advantage (HMO-POS D-SNP) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $8,300 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Tribute Advantage (HMO-POS D-SNP) are defined below.

Additional Benefits and Coverage

Yes
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing

Tribute Advantage (HMO-POS D-SNP) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Tribute Advantage (HMO-POS D-SNP) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. Tribute Advantage (HMO-POS D-SNP) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Not covered
Over the counter drug benefits
Limited coverage
In-home support services
Not covered
Home and bathroom safety devices
Not covered
Meals for short duration
Limited coverage
Annual physical exams
Not covered
Telehealth
Limited coverage

Plan Benefits and Coverage Details

Monthly Premium
$0
Health Portion of Premium
$0
Drug Portion of Premium
$0
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$8,300 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes
Doctor Lookup Link
http://www.tributebenefits.com
Plan Link
http://www.tributebenefits.com

Medical Benefits

Doctor Services

Primary doctor visit
In-network: $0 copay
Out-of-network: 20% coinsurance per visit
Specialist visit
In-network: $0 copay
Out-of-network: 20% coinsurance per visit

Tests, labs, & imaging

Diagnostic tests & procedures
In-network: $0 copay
Out-of-network: 20% coinsurance
Lab services
In-network: $0 copay
Out-of-network: 20% coinsurance
Diagnostic radiology services (like MRI)
In-network: $0 copay
Out-of-network: 20% coinsurance
Outpatient x-rays
In-network: $0 copay
Out-of-network: 20% coinsurance
Emergency care
$0 copay
Urgent care
$0 copay

Hospital Services

Inpatient hospital coverage
In-network: $0 copay
Out-of-network: In 2023 the amounts for each benefit period are:
$1,600 deductible for days 1 through 60
$400 copay per day for days 61 through 90
Outpatient hospital coverage
In-network: $0 copay
Out-of-network: 20% coinsurance per visit

Skilled nursing facility

Skilled nursing facility
In-network: $0 copay
Out-of-network: In 2023 the amounts for each benefit period are:
$0 copay for days 1 through 20
$200 copay per day for days 21 through 100

Preventive services

Preventive services
In-network: $0 copay
Out-of-network: 20% coinsurance

Ambulance

Ground ambulance
In-network: $0 copay
Out-of-network: 20% coinsurance

Therapy services

Occupational therapy visit
In-network: $0 copay
Out-of-network: 20% coinsurance
Physical therapy & speech & language therapy visit
In-network: $0 copay
Out-of-network: 20% coinsurance

Mental health services

Outpatient group therapy with a psychiatrist
In-network: $0 copay
Out-of-network: 20% coinsurance
Outpatient individual therapy with a psychiatrist
In-network: $0 copay
Out-of-network: 20% coinsurance
Outpatient group therapy visit
In-network: $0 copay
Out-of-network: 20% coinsurance
Outpatient individual therapy visit
In-network: $0 copay
Out-of-network: 20% coinsurance

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
In-network: $0 copay
Out-of-network: 20% coinsurance per item
Prosthetics (like braces, artificial limbs)
In-network: $0 copay
Out-of-network: 20% coinsurance per item
Diabetes supplies
In-network: $0 copay
Out-of-network: 20% coinsurance per item

Prescription Drug Benefits

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseGap coverage phaseCatastrophic coverage phase
Preferred Generic


Generic drugs :
25%

Brand-name drugs :
25%


Generic drugs :
$4.15 copay or 5% (whichever costs more)

Brand-name drugs :
$10.35 copay or 5% (whichever costs more)

Generic
Preferred Brand
Non-Preferred Drug
Specialty Tier

Part B Drugs

Chemotherapy drugs
In-network: $0 copay
Out-of-network: 20% coinsurance
Other Part B drugs
In-network: $0 copay
Out-of-network: 20% coinsurance

Extra Benefits

Hearing

Hearing exam
In-network: $0 copay
Out-of-network: 20% coinsurance
Fitting/evaluation
In-network: $0 copay
Out-of-network: No Data
Hearing aids - All types
In-network: $0 copay
Out-of-network: No Data

Preventive Dental

Oral exam
In-network: $0 copay
Out-of-network: No Data
Cleaning
In-network: $0 copay
Out-of-network: No Data
Fluoride treatment
In-network: $0 copay
Out-of-network: No Data
Dental x-rays
In-network: $0 copay
Out-of-network: No Data

Comprehensive dental

Non-routine services
In-network: $0 copay
Out-of-network: No Data
Diagnostic services
In-network: $0 copay
Out-of-network: No Data
Restorative services
In-network: $0 copay
Out-of-network: No Data
Endodontics
In-network: $0 copay
Out-of-network: No Data
Periodontics
In-network: $0 copay
Out-of-network: No Data
Extractions
In-network: $0 copay
Out-of-network: No Data
Prosthodontics, other oral/maxillofacial surgery, other services
In-network: $0 copay
Out-of-network: No Data

Vision

Routine eye exam
In-network: $0 copay
Out-of-network: No Data
Contact lenses
In-network: $0 copay
Out-of-network: No Data
Eyeglasses (frames & lenses)
In-network: $0 copay
Out-of-network: No Data
Eyeglass frames (only)
In-network: $0 copay
Out-of-network: No Data
Eyeglass lenses (only)
In-network: $0 copay
Out-of-network: No Data
Upgrades
In-network: $0 copay
Out-of-network: No Data

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